title: Anomalous coronary arteries: cardiovascular computed tomographic angiography for surgical decisions and planning.
abstract: Cardiovascular computed tomographic angiography (CCTA) provides an understanding of the three-dimensional (3D) coronary artery anatomy in relation to cardiovascular thoracic structures important to the surgical management of anomalous coronary arteries (ACAs). Although some ACA variants are not clinically significant, others can lead to ischemia/infarction, related acute ventricular dysfunction, ventricular arrhythmias, and sudden cardiac death. The CCTA is important to surgical decision making, as it provides noninvasive visualization of the coronary arteries with (1) assessment of origin, course, and termination of coronary artery anomalies in the context of 3D thoracic anatomy, (2) characterization of anatomy helpful for differentiation of benign versus hemodynamically significant variants, (3) identification of other cardiothoracic anomalies, and (4) detection of coronary artery disease. High-risk ACA anatomy in the appropriate clinical setting can require surgical intervention with decisions including minimally invasive versus open sternotomy approach, correction via reimplantation of a coronary artery, alteration of the ACA course without reimplantation, or bypass of an ACA. Given the rarity of ACA, there is limited data in the literature, and significant controversy related to the management issues. The management of ACA requires comprehensive clinical history, thorough assessment of cardiac function, and detailed anatomic imaging. Future studies will need to address the long-term outcome based on detailed assessment of original anatomy and surgical approach.
authors.affiliation: Division of Cardiovascular Medicine/Cardiovascular and Thoracic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. shinbane@usc.edu
authors.forename: Jerold S
authors.initials: JS
authors.lastname: Shinbane
authors.forename: Jabi
authors.initials: J
authors.lastname: Shriki
authors.forename: Fernando
authors.initials: F
authors.lastname: Fleischman
authors.forename: Antreas
authors.initials: A
authors.lastname: Hindoyan
authors.forename: James
authors.initials: J
authors.lastname: Withey
authors.forename: Christopher
authors.initials: C
authors.lastname: Lee
authors.forename: Alison
authors.initials: A
authors.lastname: Wilcox
authors.forename: Mark
authors.initials: M
authors.lastname: Cunningham
authors.forename: Craig
authors.initials: C
authors.lastname: Baker
authors.forename: Ray V
authors.initials: RV
authors.lastname: Matthews
authors.forename: Vaughn
authors.initials: V
authors.lastname: Starnes
mesh_terms: D013504:Cardiovascular Surgical Procedures; D017023:Coronary Angiography / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: anomalous coronary arteries; cardiovascular computed tomographic angiography; cardiovascular imaging; cardiovascular surgery; computed tomography; congenital heart disease